Innovation driving pharmacy today...What is innovation? Deﬁnition Translating an idea into...

Innovation driving pharmacy today

Mitch Larson9/12/2020

Pharmacist Objectives:1. Describe the impact of past pharmacy innovations on the

advancement of the practice of pharmacy2. Evaluate the ways in which new innovations can be

implemented in your practice to provide better patient outcomes.

3. Address common misconceptions surrounding the innovations in pharmacy, and discuss how they can be impactful in practice today.

Pharmacy Technician Objectives:1. Describe the role of a pharmacy technician as pharmacy

continues to evolve with new innovations2. Examine the viability of technicians performing their duties

safely and accurately without the pharmacist supervision associated with traditional pharmacy methods

Learning Objectives

Agenda

What is innovation?1

Why do we need to innovate?2

How do we innovate?3

Pharmacy innovations of today4

What is innovation?

1

What is innovation?

Definition

Translating an idea into something that creates value

1

Image of a bag of $$$Image of bubble wrapWhich was originally created for wall paper but failed miserably

Everyday examples

Twitch - Livestreaming

Uber/Lyft - Ridesharing

Square - Payments

Milk substitutes - Oat Milk

Meatless meat - impossible burger, beyond burger

What is innovation?1

Why do we need to innovate?

2

Source: https://www.ncpanet.org/home/ncpa-digest

2.1%

3.1%3.3%

Average Net Operating Income

Pharmacies struggle to be profitable


Industry Pressures Mail order pharmacies

Practitioner dispensing

Reduced reimbursement fees

Increased competition

Industry Opportunities

Technological advancements

Patient-centered care

Demand from MUA’s

Proven safety and efficiency of existing technologies


Vaccines

Mortar & Pestle

Advances in pharmacy increase safety & efficiency

Inventory Management (auto re-order)

Automation

Time Release Medications

Fax Machines

Direct Billing


Unit dose drug distribution

Years

35 years 35 years

IV Admixture programs

Pharmacist on patient care

team

40 years

25 years

Pharmacy computerization

15 years

Automated dispensing

Slow adoption of past pharmacy innovations


Data from ASHP National Survey

Unit dose drug distribution

Years

35 years 35 years

IV Admixture programs

Pharmacist on patient care

team

40 years

25 years

Pharmacy computerization

15 years

Automated dispensing

Slow adoption of past pharmacy innovations


Data from ASHP National Survey

30 yr. average

Innovation adoption lifecycle


What happens when we don’t innovate?


How do we innovate?

3

Pharmacists need to find ways to:


Increase revenue by adding value

Implement innovative practices

Reduce or better optimize costs

Practice at top of their license


Role of the pharmacist has changed

1900

1950s

1980’s

1990’s-2000’s

Apothecary as middleman between science & health

Large-scale manufacturing turns Rph towards patient care

RPhs integration with healthcare team

Outcomes-focused approaches gain

momentum

Today

Technology driven efficiencies and innovations

Pharmacy innovations of today

4

Learning Objectives

High

Medium

Low

Pharmacy Innovations of today4

Low hanging fruit● Creative delivery solutions● Digital Pharmacy● MTM


● What● Why● How● Examples


Creative Delivery Solutions

The demand [for delivery] is huge and it’s only growing...two years from now, if a pharmacy doesn’t have prescription delivery as a base offering that they actively market, then competing for patients will prove insurmountable.

Nick Potts, Founder and CEO of ScriptDrop

https://www.pbahealth.com/pharmacy-delivery-service

● What started with the foods industry service has spread to almost every other sector of retail.

● Food delivery service is predicted to be worth $76 billion by 2022


Examples.Storage Lockers.

● Systems that store and deliver completed prescriptions for convenient pickup (sometimes 24/7)

.Kiosks ● Systems that dispense prescriptions in high

pharmacy traffic areas● After hours pharmacy access


Examples.Drone

● Prescription is filled at the pharmacy ● Drone delivery to patient’s location or home

Driver-based delivery.● Delivery becomes part of workflow with real-time tracking ● Prescription filled at closed or open-door pharmacy● Delivered by a courier service or by the company● Patient can request counseling from via phone


88% vs 56%

76% of independent pharmacies offer delivery services

32% boost in adherence amongst statin users

Source: 2019 NCPA digesthttps://www.pcmanet.org/researchers-find-home-delivery-of-medications-improves-adherence-for-stroke-patients/

Why


Home delivery In store pick-up

https://www.pcmanet.org/researchers-find-home-delivery-of-medications-improves-adherence-for-stroke-patients/


HI THERE Rx

How

Employer campus

College campus

Rx delivery with remote counseling

OR



Digital Pharmacy

Mobile and web platforms that connect patients with pharmacies, health care providers, or health care systems

Can help patients increase adherence, compliance, understanding, and overall improve outcomes

Digital Pharmacy

● Location awareness: ○ Tools used to pinpoint location ○ Geofencing, WiFi locator, GPRS data

● Texting/app services○ Messaging used at appropriate times to remind patient to return to

pharmacy■ Refill reminders ■ Immunizations■ Clinical service offerings

Digital Pharmacy

Examples

.Mscripts, Digital Pharmacist etc.● Encourages self-service processes ● Enables pharmacists to do more clinical tasks● Helps staff do less management of patient profiles and

the day-to-day reminders● Drives other clinical services while patient is actively in

pharmacy

Digital Pharmacy

Why

Digital Pharmacy

Shortens gap between fills Adds 3 or more fills

per year

Higher patient retention99% Retention Rate

on platform

Quick refill response 50% of pts refill

within 2hrs of text

3+ 99% 2hrs

Source: https://www.mscripts.com/

How

Digital Pharmacy

HI THERE PHARMACY



Medication Therapy Management


Medication Synchronization

79%


77%

Independent community pharmacies offer a variety of services

Source: https://www.ncpanet.org/newsroom/news-releases/2019/10/29/ncpa-releases-2019-digest

MTM Services: ● TIPs● CMRs● Adherence programs● Med reconciliations

https://www.ncpanet.org/newsroom/news-releases/2019/10/29/ncpa-releases-2019-digest

● Utilize shifting role of the pharmacist● Holistic health outcomes approach● Pharmacy techs and Interns to assist with MTM delivery


⬆ time with pts⬆ clinical services

⬇ time dispensing

Examples

.OutcomesMTM, Equipp, APCI, Star Rating system.New Service Offerings

● Lab and Health Test Monitoring● Well child exam● Preconception care● Social Determinants of Health ● Disease state education


When pharmacy techs and interns assist with MTM delivery pharmacies


$100 M 2X

Revenue earned at participating MTM locations in 2018

Have higher CMR completion and TIP success rates

Earn more MTM revenue

Source: https://www.outcomesmtm.com/pharmacy/

Why

https://www.outcomesmtm.com/pharmacy/

How


CONSULTATION

Medium hanging fruit● Point of care testing● Telepharmacy




Point of Care Testing

● Pharmacists are the most visited healthcare professionals● Number of clinical services provided is increasing





Examples● Rapid, reliable diagnostic testing performed outside of a laboratory to identify or manage

chronic diseases and acute infections




Why

● Predicted shortage of up to 55,000 PCPs by 2032

● Pharmacist is the most accessible health care professional

● Boosts patient outcomes and satisfaction

● POCT is predicted to exceed immunizations as a driver of revenue

https://www.medicaleconomics.com/news/why-primary-care-crisisand-how-fix-it


How

● Determine which services to provide ● Obtain CLIA waivers● Applicable staff training and credentialing● Setup site and equipment● Market your new service offerings



Telepharmacy

independent rural pharmacies closed

1,231

Source: Update: Independently Owned Pharmacy Closures in Rural America, 2003-2018; RUPRI Center for Rural Health Policy Analysis, Rural Policy Brief July 2018; Abiodun Salako, MPH; Fred Ullrich, BA; Keith J. Mueller, PhD

630rural communities lost

their only pharmacy

Independent Rural Pharmacies 2003-2018

7,624

6,393

12.1%decrease

2007-2009

7.2%decrease

16.1%decrease

Telepharmacy

INPATIENT OUTPATIENT

Remote order entry review

IV admixture

Retail telepharmacy

Remote counseling

4 types of telepharmacy:

Telepharmacy

Retail telepharmacy New prescription arrives at Pharmacy A1

Technician A fills, taking images of the process2

Pharmacist B reviews images to verify fill is accurate

3

Patient picks up Rx at Pharmacy A and Pharmacist B counsels

4Tech

BHost Pharmacy

RPh TechRx

ATelepharmacy

Telepharmacy

Improve medication adherence rates

Expand access to new patient populations

Increase clinical interventions

WhyPharmacists have an opportunity with telepharmacy

Telepharmacy

HowRetail Telepharmacy Use Cases

● Community pharmacy (rural or urban)● Outpatient hospitals & health system pharmacies ● CHC & FQHC● Specialty pharmacy● Mental health centers● Employer campuses & schools● Physician’s offices ● Emergency preparedness● After hours care● Sick/vacation coverage● And more…

TelePharmacy

High hanging fruit● Genetic testing and pharmacogenomics● Compounding




Genetic Testing & Pharmacogenomics


Increasing interest in genetics

26 million consumers have taken at home ancestry tests

Source: https://www.technologyreview.com/2019/02/11/103446/more-than-26-million-people-have-taken-an-at-home-ancestry-test/

https://www.technologyreview.com/2019/02/11/103446/more-than-26-million-people-have-taken-an-at-home-ancestry-test/


260+ medications have information on how genes affect them in their drug labeling

Genetics impact on medications

Source: http://www.personalizedmedicinecoalition.org/Education/The_Basics, https://www.drugtopics.com/article/pharmacogenomics-and-future-pharmacy

http://www.personalizedmedicinecoalition.org/Education/The_Basics

Examples.Ancestry, 23andMe*.

● DNA and ancestry data

FDA in-vitro diagnostic tests● HIV & Cancer drugs are already using these services● Other drug classes:

○ Antidepressants○ Anticoagulants○ Asthma, etc...


Why

● Pharmacists are perfectly placed to own the pharmacogenomics space

● Further strengthens pharmacist patient relationship

● No other healthcare providers have entered the space on this level


How




Compounding

● Originally medicine started off as a “one size fits all”● All patients may not be able to tolerate the commercially available drug● Results in low adherence and/or complications

Compounding

ExamplesTraditional compounding

● Customizable strength or form● Add flavoring ● Reformulate to exclude unwanted,

non-essential ingredients

.PolyPill.● Multiple medications into one pill

● Statins, blood pressure and ASA combo studies showed reduced risk vs placebo

Compounding

Examples.3D drug printing.

● Polypills, including vitamins, that are customized for each patient

Compounding

IntelliMedicine Printer● 16 different silos each containing a

micromed● Dosing can be smartly adapted

Source: https://www.intellimedicine.com/solution

How

Compounding

patient labs 3D printer personalized capsule

What’s Next?

Innovate or Not

Examples

Innovate or Not

Innovate or Not

"The American icon (Kodak) had the talent, the money, and even the foresight to make the transition. Instead it ended up the victim of the aftershocks of a disruptive change. Learn the right lessons, and you can avoid its fate."

HBR.org

https://www.google.com/url?q=https://hbr.org/2016/07/kodaks-downfall-wasnt-about-technology&sa=D&ust=1586276559075000&usg=AFQjCNEepHZx0QcFmUlzg-Jor2atfslXCA

Innovate or Not

Innovate or Not

HI THERE PHARMACY

1/1Rx ready!

Current state: 10 days later, no immunizations

Get needed shots at pharmacy

Telepharmacy

Innovate or Not

1/2

We received a new prescription, click here to select delivery or pick up.Get needed

shots at pharmacy

HI THERE PHARMACY

HI THERE PHARMACY

Ideal state

HI THERE PHARMACY

Innovate or Not

1/2

We’re experiencing a delay in processing your prescription, but noticed you are due for some immunizations.

1/1

Your prescription is ready!

See you soon!

HI THERE PHARMACY

HI THERE PHARMACY

2/2

Click here to schedule an appointment for your immunizations.

You will be notified once your rx is ready!

HI THERE PHARMACY

HI THERE PHARMACY

Ideal state

1/1See you next week for your appointment and remember to fill out this form for your immunizations.

Innovate or Not

HI THERE PHARMACY

Ideal state

Questions? Mitch [email protected]

CE Question #1

What was the initial intended use for bubble wrap?

A. Insulation

B. Textured wallpaper

C. Cushioning for packages

D. Skydiving landing pads

CE Question #2

The average net income in pharmacies has steadily decreased over the last several years.

A. True

B. False

CE Question #3

Which of these are examples of creative deliver solutions you can implement for your pharmacy?

A. Storage lockers

B. Kiosks

C. Drone delivery

D. All of the above

CE Question #4

Which of the following is a free and effective way to communicate with your local community?

A. Social Media

B. Local TV commercials

C. Graffiti in public restrooms

D. Bus bench ads

CE Question #5

What is the retention rate for digital pharmacy platforms?

A. 12%

B. 82%

C. 79%

D. 99%

CE Question #6

According to the NIH, what percentage of a pharmacist’s time is spent doing non-clinical tasks?

A. 20%

B. 40%

C. 60%

D. 80%

CE Question #7

Point-of-care testing is predicted to exceed immunizations as a driver of revenue.

A. True

B. False

CE Question #8

Telepharmacy allows:

A. Pharmacists to provide pharmacy services to underserved patient populations.

B. Pharmacies to operate low-volume pharmacies where the traditional model isn’t feasible.

C. Workload balancing between multiple pharmacies to free up pharmacist time for clinical activities.

D. All of the above.

CE Question #9

Genetic testing allows for more specific formulation of medications based on an individual’s genetic makeup.

A. True

B. False

CE Question #10

Blockbuster, Kodak, and the taxi industry are all good examples of innovating to meet the demands of the market.

A. True

B. False

Innovation driving pharmacy today...What is innovation? Deﬁnition Translating an idea into...

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